Application for Membership

CONGRATULATIONS ON YOUR DECISION TO LOOK CLOSER AT THE AMERICAN ACADEMY OF ESTATE PLANNING ATTORNEYS TOOLS, SYSTEMS AND MEMBERSHIP!

Whether you’re attending our upcoming Boot Camp and Summit, or you know for certain you’re ready to join the Academy Membership, we will need to process and approve this Application as part of our qualification process. Please be frank about the location of all branch offices as well as any disciplinary action you’ve experienced. We recognize that whether your practice is a well established Estate Planning practice, you’re leaving an existing firm and going out on your own, or you’re changing directions and shifting from one type of practice into Estate Planning for the first time—this takes capital. We work hard to ensure the Members who join the Academy are in a secure financial position. Please be candid about your available resources so we can properly advise you about the timing of Membership or execution of other goals.

We appreciate your interest in the Academy! We look forward to talking with you soon.

PERSONAL INFORMATION

Applicant's Full Name:*

FirstMiddleLastJr./Sr./II/III

Alias or Maiden Name:

Birthdate:*

Soc. Sec. No:*

Main Office Address:*

City, State, Zip:*

Phone:*

Cellular:*

Email:*

How did you hear about us?*

BRANCH OFFICES (IF ANY)

Street Address:

City, State, Zip:

Phone:

Fax:

Street Address:

City, State, Zip:

Phone:

Fax:

LAW FIRM INFORMATION

My law firm is set up as:*

Sole Proprietor

Corporation

LLC

LLP

I am a partner in the law firm of

I am a stockholder in a corporation

Have you filed bankruptcy within the last ten years, or do you have any outstanding judgments filed against you?*

No

Yes (Please explain with an attachment)

Do you carry Malpractice Insurance?*

Yes

No. If I join, I will meet the requirements.

*
All Members of the American Academy of Estate Planning Attorneys are required to obtain Malpractice Insurance. Make sure
that you meet our Malpractice Insurance Requirement of $250,000 per incident, $500,000 per year. We recommend, however,
that you have insurance coverage for $500,000 per incident, $1 million aggregate per year.

Number of claims against your Malpractice Insurance in the last 10 years:*

If any claims were brought against your Malpractice Insurance, please attach an additional sheet with an explanation.

FINANCIAL INFORMATION

My financial resources are approximately:*

$50K-$100K

>$100K

I feel I am in a strong financial position

I do not have confidence in my financial position

Comments:*

PROFESSIONAL INFORMATION

Education

1)- UNDERGRADUATE

DEGREE DATE:

SPECIALTY/MAJOR:

SCHOOL:

DISTINCTIONS:

2)- LAW SCHOOL

DEGREE DATE:

SPECIALTY/MAJOR:

SCHOOL:

DISTINCTIONS:

3)- POST-GRADUATE WORK
(E.G. LL.M., CPA)

DEGREE DATE:

SPECIALTY/MAJOR:

SCHOOL:

DISTINCTIONS:

4)- SPECIALTY

DEGREE DATE:

SPECIALTY/MAJOR:

SCHOOL:

DISTINCTIONS:

4)- OTHER

DEGREE DATE:

SPECIALTY/MAJOR:

SCHOOL:

DISTINCTIONS:

LICENSES TO PRACTICE LAW

1)-

STATE:

DATE OF ADMISSION:

BAR LICENSE #:

2)-

STATE:

DATE OF ADMISSION:

BAR LICENSE #:

3)-

STATE:

DATE OF ADMISSION:

BAR LICENSE #:

DISCIPLINARY PROCEEDINGS

If you answer “Yes” to any of the following questions, please attach a separate sheet with an explanation

Have you ever been publicly or privately censured or disciplined by your Supreme Court Ethics Committee or State Bar Association?*

Yes

No

Have you ever been disbarred from practicing or voluntarily relinquished your license to practice law in any state?*

Yes

No

Have you ever been convicted of a felony?*

Yes

No

Have you ever had any securities license or insurance license suspended or revoked?*

Yes

No

Have you ever had any disciplinary proceedings with the SEC, NASD, or any state regulatory body?*

Yes

No

PROFESSIONAL LEGAL REFERENCES

PLEASE GIVE US THE NAMES AND ADDRESSES OF THREE PROFESSIONAL LEGAL REFERENCES

Reference 1 Name:

First

Street Address:

City, State, Zip:

Phone:

Email:

Reference 2 Name:

First

Street Address:

City, State, Zip:

Phone:

Email:

Reference 3 Name:

First

Street Address:

City, State, Zip:

Phone:

Email:

AUTHORIZATION TO VERIFY INFORMATION

I hereby authorize the American Academy of Estate Planning Attorneys to verify all information contained in this application, including contacting individuals, financial institutions, credit reporting agencies, and the appropriate Bar Associations, SEC, NASD, and conducting a thorough background check.
I understand that false and/or inaccurate information on this application could result in forfeiture of my opportunity to
become a Member of the American Academy of Estate Planning Attorneys.
I understand that all information reported on this application will be held in strict confidence by the American Academy
of Estate Planning Attorneys.
The information contained in this application is truthful and complete to the best of my knowledge and belief. A facsimile copy
of this signed Membership Application and Authorization to Verify Information shall be considered as valid as the original.

Firm Name:*

Date:*

File

Signature

*

I understand that checking this box constitutes a legal signature confirming my application for AAEPA membership.

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By using the American Academy of Estate Planning Attorneys Member directory, you are agreeing to abide by the following Terms of Use. The AAEPA Member Directory may be used exclusively for the purposes of allowing consumers to locate an estate planning professional, or allowing other professionals to locate colleagues for co-counsel, consulting, or other professional assistance. Use for any commercial purpose, including solicitation of products or services is strictly prohibited. Persons who use the Member Directory for any unauthorized purpose may be subject to legal action. Any person who uses this site or its content for any commercial purposes will be liable to AAEPA for liquidated damages in the amount of $100,000, which represents a reasonable estimate of AAEPA's damages.